FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

COLD HANDS WARM HEART MUST BE RAYNAUD'S SYNDROME

Question: I was diagnosed with Raynaud's syndrome, but the doctor didn't provide any information. So far, only my fingers seem to be affected since this started six months ago. I seem to be gradually getting worse. Is this something I just need to learn to live with, or is there treatment available?

Answer: Raynaud's syndrome, which is also called Raynaud's disease, is a problem with circulation. It most commonly involves the hands as you are experiencing and the feet. In this illness the small arteries that nourish these parts temporarily close off after only mild exposure to cold. Raynaud's syndrome is actually an exaggeration of a normal body reaction to cold temperatures. This natural reflex shifts blood toward the heart and lungs to conserve heat and allow us to live in colder environments.

In Raynaud's disease this normal reduction in blood flow to the hands and feet is carried out to an extreme degree. The hands, feet or both can become quite cold when the weather is only cool. On cold days the circulation in these areas may be so severely reduced that they become blue and painful.

Raynaud's is sometimes a consequence of illness. The most common illness that is associated with Raynaud's is an auto-immune disease called scleroderma. However, the diagnosis is complicated by a delay that may be as long as 20 years from the first signs of Raynaud's until the appearance of other signs of scleroderma. Other individuals develop this condition without a link to any other apparent illness.

Raynaud's syndrome is often more of a nuisance than it is a serious disability, as I hope it will be for you. Most individuals suffering with the illness are comfortable if they just keep their hands and feet warm. This is true even though the condition does tend to get progressively worse as the years pass.

The most effective treatment is the avoidance of cold weather. That is more of a problem for you since you live here in Ohio, than it is for readers in the South. For you, this means being the first person in your neighborhood to get out warm boots and mittens. And I stress "mittens" because when wearing them, each finger warms its neighbor. Therefore, they are much warmer than gloves. It is also important to avoid the use of tobacco and cough, cold, and sinus remedies that contain decongestants since all of these can worsen the circulation problems of this illness.

Medications in the "beta blocker" family are used for many heart conditions and for high blood pressure. These medications make Raynaud's much worse, and therefore, should be avoided. Medications in the "calcium channel blocker" family can provide some relief of the symptoms, but they can't "cure" it. In the most severe cases, surgery is tried once in a while, but the results are often disappointing.

I recommend that you talk with your doctor about your Raynaud's syndrome. He or she will be sure that any medications you need won't make your condition worse. And, if your symptoms are sufficiently severe, he or she may ask you to take a calcium channel blocker.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.